Published online Oct 26, 2025. doi: 10.12998/wjcc.v13.i30.109212
Revised: May 25, 2025
Accepted: August 12, 2025
Published online: October 26, 2025
Processing time: 161 Days and 20.9 Hours
Acute liver failure (ALF) is a life-threatening multisystemic condition with high short-term mortality. With the growing prevalence of obesity and metabolic syndrome, it is important to investigate the clinical implications of high body mass index (BMI) on survival outcomes in ALF.
To explore the impact of overweight and obesity on the clinical outcomes of patients with ALF.
A retrospective observational cohort study was conducted involving patients with ALF admitted to the Johns Hopkins Health System between January 1, 2000 and May 1, 2020. We performed Cox proportional hazards regression to identify outcomes, including the need for liver transplantation (LT) or all-cause mortality.
A total of 196 patients were included, the median age was 43.5 years, 63.3% were female, and 59.7% were of Caucasian ethnicity. Acetaminophen-induced ALF was the most common etiology (45%). The mean BMI was significantly greater among patients who underwent LT or died (29.64 kg/m2vs 26.59 kg/m2, P = 0.008) than among survivors. Patients with overweight and obesity had a higher risk of all-cause mortality or need for LT by 2.22-fold (95%CI: 1.30-3.78) and 2.04-fold (95%CI: 1.29-3.39), respectively. Elevated BMI was associated with renal failure and higher grades of hepatic encephalopathy. Derangements in serologic markers, including alanine transaminase, lactate, and ammonia, were associated with a mortality risk or need for LT.
In this large, retrospective study, with a diverse cohort of United States patients, Overweight and obese were independently associated with an increased risk of all-cause mortality or need for LT. This work highlights the importance of closely monitoring ALF patients who are overweight or obese for adverse complications and measures to improve outcomes in this vulnerable patient population.
Core Tip: The most common causes of acute liver failure (ALF) were acetaminophen toxicity, drug-related hepatitis, and other etiologies. Patients who underwent liver transplantation (LT) or died were older, had a higher body mass index (BMI), and were more likely to have higher-grade hepatic encephalopathy and cerebral edema. They also had higher levels of lactate and phosphate. Overweight and obese patients with ALF had a higher risk of mortality or the need for LT than normal-weight patients. Factors such as increasing age, other etiologies of ALF, higher BMI, and abnormal laboratory values were associated with an increased risk of poor outcomes in ALF patients.